Functional properties of the surface of the vermilion border of the lips are distinct from those of the facial skin

BACKGROUND: The vermilion border of the lips (lip for short) is the only part on the face where the oral mucosa is persistently exposed to the outside. Despite its prominent presence on the face, constituting not only the target of cosmetics but also the site for various skin diseases, its functional properties remain almost unknown. OBJECTIVES: To elucidate the functional properties of the vermilion border of the lips. METHODS: We studied the biophysical properties of the lip by comparing them with those of the cheek skin in 303 healthy Japanese females aged 21-80 years, in winter. We used a closed-chamber system to measure transepithelial water loss (TEWL) of the lip to avoid the effect of breathing. Moreover, we examined the effects of oral etretinate, a drug that definitely produces dry, scaly lips, on the lips of seven male patients aged 49-89 (average 67) years. RESULTS: TEWL was significantly almost three times as high on the lips as that on the cheek which is a site that shows far higher levels than do other body areas. TEWL decreased with age more remarkably on the lip than on the cheek. High-frequency conductance, a parameter for surface hydration state, was significantly lower on the lip than on the cheek. The mean values obtained were about one-third of those on the cheek, and no age-related changes were observed either on the lip or on the cheek. The superficial epithelial cells on the lip were parakeratotic and larger than those of the cheek skin. Furthermore, we detected a significant increase in TEWL on the lip as well as on the cheek of patients treated with oral etretinate. CONCLUSIONS: It appears that the incomplete corneocyte formation of the lip surface is responsible for the poor barrier function and water-holding capacity.     

Influence of age and hormone replacement therapy on the functional properties of the lips

Aims: To investigate the influence of age and hormonal status on some functional properties of the lips of women.
Methods: Lips properties were measured and compared through four groups of women (young with normal menses, aged with normal menses, aged and menopaused, aged, menopaused receiving hormonal replacement therapy). The following parameters were recorded: sebum excretion rate on the forehead. On the lower lip: TEWL, mechanical damping, color, tactile acuity. Moreover, capacitance images of each lips were recorded and the mean capacitance measured.
Results: Changes in TEWL, mechanical damping and tactile acuity appear clearly linked to age while the increase in lip darkness could be due to hormones. Sebum excretion rate is also clearly linked to hormonal status. Surprisingly, no changes of lips capacitance were detected vs. age or hormonal status. This study confirms that upper lip is more hydrated than the lower one.
Conclusion: Most of the parameters measured on the lips have similar variations than the same parameters measured on the skin. Only sebum and color appear being dependant on the hormonal status.     

Age-related changes in skin wrinkles assessed by a novel three-dimensional morphometric analysis

BACKGROUND: A system has been developed whereby the morphology of the skin surface can be evaluated directly in three dimensions. This system employs a non-invasive device that utilizes white light of halogen origin, and which allows the computation of wrinkle depth and width, and other parameters of skin surface morphology. Using innovative engineering, an optical system has been devised so that light is transmitted via a slit and can be used to measure not only replicas of the skin but also the skin surface directly. The measurement area is 6.4 x 6.4 mm, and the theoretical resolution with a x 50 magnification lens is within 12.5 micro m. OBJECTIVES: To use this system to study age-related changes in the morphology of wrinkles at the eye corner areas of women of varying ages. METHODS: One hundred and one healthy women (age range 20-80 years) residing in the Tokyo area were the subjects used in this study. RESULTS: Wrinkles demonstrated a rapid increase in depth in women aged 40 years or older, and plateaued at the age of 60 years. Surface morphology parameters yielded results similar to those of age-related changes in wrinkles. CONCLUSIONS: This new analytical system provides a rapid and convenient non-invasive method to evaluate skin surface morphology in three dimensions, especially with respect to wrinkle formation. The results obtained using this system provide a deeper insight into the mechanistic relationship between wrinkles and skin elasticity.     

Improving lip wrinkles: lipstick-related image analysis

BACKGROUND/PURPOSE: The appearance of lip wrinkles is problematic if it is adversely influenced by lipstick make-up causing incomplete color tone, spread phenomenon and pigment remnants. It is mandatory to develop an objective assessment method for lip wrinkle status by which the potential of wrinkle-improving products to lips can be screened. The present study is aimed at finding out the useful parameters from the image analysis of lip wrinkles that is affected by lipstick application. METHODS: The digital photograph image of lips before and after lipstick application was assessed from 20 female volunteers. Color tone was measured by Hue, Saturation and Intensity parameters, and time-related pigment spread was calculated by the area over vermilion border by image-analysis software (Image-Pro). The efficacy of wrinkle-improving lipstick containing asiaticoside was evaluated from 50 women by using subjective and objective methods including image analysis in a double-blind placebo-controlled fashion. RESULTS: The color tone and spread phenomenon after lipstick make-up were remarkably affected by lip wrinkles. The level of standard deviation by saturation value of image-analysis software was revealed as a good parameter for lip wrinkles. By using the lipstick containing asiaticoside for 8 weeks, the change of visual grading scores and replica analysis indicated the wrinkle-improving effect. As the depth and number of wrinkles were reduced, the lipstick make-up appearance by image analysis also improved significantly. CONCLUSION: The lip wrinkle pattern together with lipstick make-up can be evaluated by the image-analysis system in addition to traditional assessment methods. Thus, this evaluation system is expected to test the efficacy of wrinkle-reducing lipstick that was not described in previous dermatologic clinical studies.     

Collagen induction therapy for the treatment of upper lip wrinkles

Upper lip wrinkles are very common and impair the quality of life of many people due to their perceived unsightly appearance. Several options are available today for their treatment. A new therapeutic option, called collagen induction therapy (CIT), seems to be effective and safe for the treatment of upper lip wrinkles. The aim of this study is to demonstrate the efficacy and safety of CIT in the treatment of upper lip wrinkles. Ten female subjects, aged 50-65 years old, with upper lip wrinkles were enrolled. Each patient was treated with a specific tool in two sessions. Using a digital camera, photographs were taken of all the patients to evaluate the depth of the wrinkles and a silicon-print technique was used to obtain a microrelief impression of the wrinkles. Data of the cutaneous casts were analyzed by computerized image analysis. Analysis of the patients' photographs, supported by the sign test, and of the degree of irregularity of the surface microrelief, supported by Fast Fourier Transform and by wrinkle image processing, showed that, after only two sessions, the wrinkles' severity grade in most patients was greatly reduced. The present study confirms CIT as an effective and safe technique to improve upper lip wrinkles.     

女性外眦皱纹(鱼尾纹)分型及相关因素的分析

目的分析中国女性外眦皱纹(鱼尾纹)类型特征及其相关因素。方法采用问卷调查的方法收集人口社会学一般资料以及调查可能影响皮肤老化的主要相关因素。使用图像分析仪SIA0612标准化拍照,采用VisioscanVC98(CK Electronic Gmb H,Germany)进行外眦区域皱纹测量。Photoshopcs2截取双侧眼角固定比率皮肤图像。采用Lemperle分级标准将外眦皱纹分为0～5级。依照Kane鱼尾纹分型对研究对象外眦皱纹进行分型。结果共调查150名南京地区中国女性,年龄19～59岁,平均年龄37.9岁,Fitz-patrick皮肤类型以Ⅲ型为主(占66%),运动状态时(闭眼微笑)时在19～25岁组鱼尾纹发生率是22.2%,在40～44岁年龄组达到100%。115名具有外眦皱纹的中国女性受试者分型以Ⅳ型为主,与白人女性不同。其中,Ⅰ型(完全扇型)13人(11.30%),Ⅱ型(下睑上颊型)12人(10.43%),Ⅲ型(上睑型)14人(12.17%),Ⅳ型(正中型)76人(66.09%)。分析皱纹分型与年龄的关系无统计学意义(P0.05),并与Fitzpatric皮肤类型不相关(P0.05),但与青年期(19～29岁)日晒情况具有统计学差异(P0.05)。结论外眦皱纹分型是独立于皱纹分级概念的,与年龄无关。本次调查的中国女性外眦皱纹分型与白人女性不同,以Ⅳ型为主,肉毒素治疗鱼尾纹时需要考虑分型的差异。青年期日晒情况可能是影响分型的因素。     

强脉冲光治疗面部皮肤老化的观察

目的 观察强脉冲光治疗面部皮肤老化如不规则色素改变、毛细血管扩张、皮肤干燥、粗糙、细皱纹的临床疗效.方法 用强脉冲光治疗178例面部皮肤老化患者,共进行4次治疗,每次间隔3～4周.治疗前后医生对患者面部皮肤进行整体评分,测定皮肤黑素指数、红斑指数和角质层含水量、治疗结束后1个月进行患者满意度自评.结果 治疗后医生主观评分改变显著,患者满意率为90.45%;第4次治疗后黑素指数和红斑指数下降最明显,其次为第1次治疗后.治疗对角质层含水量影响不显著.结论 强脉冲光可安全高效地治疗面部皮肤老化.     

Clinical features and management of schwannoma affecting the upper and lower lips

Head and neck schwannomas comprise 25–40% of all schwannomas, with presentation on the lips as the rarest and most surgically complicated site for perioral tumors. A systematic literature review was conducted to include 21 cases of patients with schwannoma of the upper or lower lips. The majority of patients presented with a single, painless, well‐encapsulated nodule on the upper or lower lips. The nodules were consistently slow‐growing, with an average 29.3 months from symptom onset to clinical presentation. Most cases were complicated by profound cosmetic disfigurement as well as dysphagia, dysarthria, snoring, and/or sleep apnea. Overall, histological analysis was consistent with classic schwannoma, and all cases were treated via complete surgical excision, and for malignant tumors, additional therapy was utilized. All but four cases achieved full remission by final follow‐up. Recurrence rate for benign lip schwannomas was 5.3%, which is remarkably different from the standard recurrence rate of 8–24% for benign peripheral schwannomas. Additionally, the proportion of malignant tumors was greater for lip schwannomas than other schwannomas. Lip schwannomas demonstrate different characteristics than schwannomas from other locations on the body, and these remarkable differences highlight significant implications for clinical practice. Complete excision is the primary mode of treatment with overall excellent postoperative prognosis and rare instances of recurrence. Given the rarity of this tumor, this review of available cases serves to comprehensively describe clinical presentation and surgical treatment approaches to upper and lower lip schwannomas.     

PERITORAL DERMATITIS

SUMMARY. —Forty cases of a perioral dermatitis, chiefly affecting young women, are described. All have been seen in Denmark and England within the last 18 months. The condition is believed to be quite common.
The clinical features are characteristic. A papulosquamous eruption affects the chin and nasolabial folds and often the upper lip but almost always spares a clear zone around the vermilion border of the lips, The lower part of the cheeks and glabellar region are less commonly involved.
The eruption pursues a fluctuating course with closely-set small papules arising on patchy or diffuse erythema. It is extremely resistant to treatment.
The aetiology is quite unknown. There is no evidence to incriminate topical agents, infection, hormonal influences, light sensitivity or emotional stress.     

Use of high-frequency ultrasound in the assessment of injectable dermal fillers

Background: The use of dermal fillers for enhancing lips and reducing wrinkles is currently one of the fastest growing sectors of the cosmetic surgery market. There are numerous fillers available, some are synthetic others are isolated from biological material. Once injected the fillers have a varied lifespan ranging from months to years depending upon the material, site of injection and individual response. Current assessment techniques of filler performance are mostly limited to evaluations of the skin surface topography, and not to what is happening to the filler beneath the skin surface. The aim of this work was to see if high‐frequency ultrasound could be used to image and measure filler dimensions in situ. Method: This was a pilot study of six healthy female volunteers aged 36–53 visiting the surgical outpatients department of a hospital in Glasgow. Volunteers had been injected with filler material into their upper lip 6 months before the visit. The patients all had their upper lip scanned using high‐frequency ultrasound. The subsequent images were then assessed using the scanner software to assess the dimensions of the filler. Results: The filler material was clearly visible with the ultrasound and subsequently measurable in each scan. Each scan procedure was completed within a short time period meaning quantitative data could be acquired with minimum trauma to the volunteer. The scan images and data also provided valuable information for the volunteers and reinforced their perception of the fillers effect on their features. Conclusions: High‐frequency ultrasound scanning provides a non‐invasive, convenient and rapid technique for the assessment of filler performance. This pilot study produced three valuable pieces of information: ? The ultrasound can image the filler material from which quantitative measurements can be made. ? The technique is rapid and cost effective …? This investigation helped to reinforce the volunteer's perception of the filler effect.     

A pilot investigation to subjectively measure treatment effect and side-effect profile of non-ablative skin remodeling using a 532 nm, 2 ms pulse-duration laser

BACKGROUND AND OBJECTIVE : Carbon dioxide laser skin resurfacing has become a standard treatment for wrinkles and sun-damaged skin. This ablative treatment, however, is associated with undesirable complications and long recovery times. A growing body of evidence suggests that dermal inflammation and subsequent collagen formation can be stimulated without removal of the epidermis, raising the possibility of effective non-ablative skin remodeling for mild to moderately photodamaged skin. MATERIALS AND METHODS : This preliminary study was performed to evaluate the safety and subject satisfaction of non-ablative skin remodeling using a 532 nm, 2 ms pulse-duration, frequency-doubled Nd:YAG laser. Subjects with mild-to-deep lip wrinkles and mild-moderate acne scarring were treated one half of their lip (wrinkles) or cheek (acne scarring), leaving the other side as an untreated control. Subjects were treated at 3-6 week intervals for an average of three treatments. Subjective assessment of improvement was estimated by subject self-evaluation of the percentage improvement over baseline, and a blinded observer attempted to identify the treated side on physical examination. RESULTS : Subjective assessment revealed an average improvement of 51.4% and 53.6% for upper lip wrinkles and facial acne scarring, respectively. Side effects were limited to transient erythema that resolved over 0.25-2 hours following treatment. CONCLUSIONS : These results demonstrate that non-ablative treatment with the 532 nm, 2 ms pulse-duration Nd:YAG laser results in subjective improvement of rhytides and acne scarring, with a high safety profile.     

Age-related alterations of echogenicity in Japanese skin

BACKGROUND: Ultrasonic methods are commonly used for the noninvasive measurement of skin thickness. The effects of ageing on the skin have been reported to differ between Asians and Caucasians. Therefore, it is possible that the echogenicity of the skin on ultrasonographic images reflects differences in the skin architecture and properties that may vary among races and environments. OBJECTIVE AND METHODS: Since there have been a few reports on ageing-related changes in ultrasonic echogenicity in Caucasian skin, but not in Asian skin, we evaluated age-related changes in the echogenicity of ultrasonographic images by the ultrasonic B mode at 3 sites on the face (forehead, eye corners, cheeks) considered as sun-exposed areas and on the ventral forearms considered as weakly sun-exposed areas in 130 Japanese females aged from 18 to 83 years. The dermis was divided into 3 layers (upper, middle, lower), and echogenicity was evaluated in each area. RESULTS: No age-related change in echogenicity was observed in the entire dermis. When the dermis was divided into 3 layers (upper, middle and lower dermis), the echogenicity was decreased in the upper layer and increased in the lower layer with age in all skin areas tested. In contrast, there were no age-related changes of echogenicity in the middle dermis. CONCLUSION: These findings suggest that, as for Caucasians, echogenicity in the upper and lower dermis is a useful tool for evaluating skin ageing in the Japanese.     

Unexpected distribution of surface hydration level of the lip

Background The functional properties of human lips depend on their hydration level. Limited data are, however, available. Objective To investigate water distribution through the lower lip surface. Methods Images from the surface of the lip were recorded using a new capacitance imaging technique. Capacitance and conductance measurements were also carried out in various points of lower lip and on adjacent skin. Results Data clearly show that the closest part of the mucosa of the lip is less hydrated than the external part. These unexpected findings could be related to the presence of a premucosa area whose structure is clearly different from that of vermilion zone.     

Sutures and Burrow''s triangles placed in the red vermilion in the surgery of upper lip defects

BACKGROUND: In upper lip defects both the design of the flap and the position of the Burrow's triangles may be reversed so as to conceal the scars among skin wrinkles, folds and the mucosal lip to maximize the aesthetic outcome. OBJECTIVE: To report two cases of upper lip defects in which both scars and Burrow's triangles were concealed in the natural folds and the vermilion. METHODS: Both surgeries were performed under local anaesthesia. RESULT: In both patients the scars were successfully concealed and the results aesthetically acceptable. CONCLUSION: The technique described can be used to conceal scars in cases of upper lip defects with aesthetically acceptable results.     

Prevalence of lip and perioral Ephelides in beach workers

BACKGROUND

Ephelides are small hyperpigmented macules common in the skin, presenting as areas with increased melanin production. Ephelides are observed in genetically predisposed individuals, particularly fair-skinned people highly susceptible to sunburn.

OBJECTIVES

This study aimed to determine the prevalence of lip and perioral ephelides in 362 beach workers in the city of Natal (Rio Grande do Norte) and to investigate potential associations with sociodemographic, occupational and general health.

METHODS

For this purpose clinical tests were performed by calibrated examiners in the epidemiological area around the lips and the area bounded laterally by the nasolabial groove and at the bottom by the chin. A questionnaire was completed and assessed. The possible associations between sociodemographic variables, occupational and general health with the presence of lip and perioral ephelides were evaluated by chi-square test for a significance level of 5%.

RESULTS

Approximately one third of the workers were affected by perioral ephelides (33.7%) and around a quarter of them by lip ephelides (24.0%). Gender was the only variable significantly associated with the presence of perioral ephelides (p = 0.002), unlike lip ephelides which proved to be significantly associated with habits (p = 0.036) and alcoholism (0.030).

CONCLUSIONS

The prevalence of ephelides in lip and perioral region was high in the study population, with gender and certain habits associated with its occurrence.     

唇部肿瘤82例皮肤外科手术分析

［摘 要］目的 对82例唇部皮肤外科手术病例进行回顾性研究,探讨唇部皮肤外科手术病例的共性、特点。方法 手术切除唇部皮损,根据缺损的部位、大小、形状及周围皮肤、黏膜情况等选择修复方法。结果 患者平均年龄49.62岁,男女性别构成比相近。患色素痣的病例最多34例（41.5%）,其余肉芽肿13例（15.9%）,鳞状细胞癌12例（14.6%）,血管瘤9（11.0%）,基底细胞癌7例（8.5%）,光化性唇炎2例（2.4%）,角化棘皮瘤2人（2.4%）,粘液囊肿2人（2.4%）,鲍温氏病1人（1.2%）。手术部位上唇47例（57.3%）,下唇35例（42.7%）。所有病例中,应用单纯闭合手术者占51例（62.2%）,应用到复杂成形技术的31例（37.8%）。结论 对于发生于唇部的皮肤恶性肿瘤及常见良性肿物除应用经典皮肤外科手段-Mohs显微外科手术完整切除肿瘤（或肿物）以外,熟练应用唇部成形修复技术也非常重要。     

Comparison of age-related changes in facial wrinkles and sagging in the skin of Japanese, Chinese and Thai women

BACKGROUND: Differences in skin aging features between Asians and Caucasians are commonly known, whereas little is known about such differences in various Asian populations. OBJECTIVE: A survey was carried out in Tokyo, Shanghai and Bangkok to identify specific features of skin aging in each population and to evaluate whether our conventional photo scale is an appropriate tool for this type of comparative study. METHODS: Eighty-seven women residing in Tokyo, 100 women residing in Shanghai, and 90 women residing in Bangkok were examined by a specialist. Facial wrinkles (forehead, glabella, upper eyelid, crow's feet, lower eyelid, cheek, nasolabial groove and mouth corner) and cheek sagging were evaluated using photo scales previously obtained from Japanese subjects. Comparisons were made according to 10-year age groups. RESULTS: Women in Bangkok showed the most severe level of wrinkles, followed by those in Shanghai in the three groups. Significant differences were observed between Thai and Japanese women in the intensity of wrinkles at many facial sites. Chinese women had significantly more severe wrinkles in the area around the eyes compared to Japanese women, while Thai women had significantly more severe wrinkles in the lower halves of their faces compared to Chinese women. In cheek sagging scores, significant differences were observed between Japanese and Thai women in their 30s and 50s, but not between Japanese and Chinese women or between Chinese and Thai women in all age groups. CONCLUSION: These results indicate variations in skin aging features among women from three Asian cities thereby suggesting the diversity of Asian skin. Our scaling method proved to be appropriate for facial wrinkles, but required modification to compare cheek sagging among Asian populations.     

Clinical,histologic, and ultrastructural changes after use of human growth factor and cytokine skin cream for the treatment of skin rejuvenation

The present study reports the clinical, histologic, and ultrastructural changes observed after the 6‐month application of a novel skin cream containing a mixture of human growth factors and cytokines. Participants were asked to apply the human growth factor and cytokine skin cream twice daily to their entire face over a period of 6 months. A 3‐mm punch biopsy was taken from the preauricular skin area before and after the treatment period. Further evaluations included photographic and clinical assessment of facial skin for wrinkles. After the treatment period, improved clinical appearance of periorbital and perioral wrinkles by 33% and 25% on average, respectively, was demonstrated. Histologic evaluation indicated moderate changes in the epidermal thickness as well as an increased fibroblast density in the superficial dermis at the end of the 6‐month treatment period. Ultrastructural changes consistent with new collagen formation were shown by electron microscopy. This study, together with earlier studies, corroborates that topical application of growth factors and cytokines are beneficial in reducing signs of facial skin aging.     

Lip cancer: retrospective analysis of 181 cases

Background: In Germany little data on the epidemiology and histology of lip cancers are available, as lip cancers are commonly pooled together with head and neck tumors. Patients and methods: Retrospective analysis of 181 patients with malignant tumors of the lips with respect to gender, location, histology, risk factors and comorbidity. Results: There were 90 women and 91 men with a mean age of 71 years. 98 had a tumor on the upper lip and 83 patients on the lower lip. Tumors of the upper lip showed a slight female preference (61%). In contrast lower lip cancer was more common (64%) in men. Histological analysis revealed that in both regions nodular basal cell carcinomas as well as squamous cell carcinomas (NOS) are the most common subtypes. Vertical tumor thickness of squamous cell carcinomas was in most cases smaller than 6 mm (n = 71) and only in 4 cases was a tumor thickness of > 6 mm detected. Altogether, 57% of the patients reported a high to very high sun exposure. Conclusions: In comparison to previous studies we found a weaker preference for women for tumors of the upper lip and also a weaker preference for men for tumors of the lower lip. The causes remain unclear, but could be causally related to an increased life expectancy and/or changed risk profile.     

Comparison of efficacy and safety of fractional radiofrequency and fractional Er:YAG laser in facial and neck wrinkles: Six‐year experience with 333 patients

Lasers and other light sources are popular treatment options for facial rejuvenation in recent years. In this study, we aimed to compare the efficacy and safety of fractional radiofrequency (RF) and fractional Erbium: YAG (Er:YAG) laser for facial and neck skin wrinkles, objectively. Three hundred and thirty‐three patients treated with fractional RF and fractional Er:YAG laser were evaluated by two blinded dermatologists. Fractional Er:YAG laser was more effective for the periorbital area; whereas fractional RF treatment was more effective for perioral, nasolabial and jawline areas. There was no statistically significant difference in side effects between two treatment groups. In conclusion, both modalities significantly improve skin wrinkles; however, it should be considered that there may be regional differences between the treatment outcomes of them.